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A Simulator for Breech Extraction of the Second Twin

Birsner, Meredith L., MD

doi: 10.1097/AOG.0000000000002609
Contents: Medical Education: Procedures and Instruments

BACKGROUND: Breech extraction of a second twin is a skill useful for any health care provider planning on undertaking vaginal delivery of twins. However, training opportunities in this skill may be limited.

METHOD: Using readily available supplies, a reusable model neoprene uterus can be constructed, as can a balloon model to simulate a fetus in the amniotic cavity.

EXPERIENCE: The model allowed demonstration of skills expected of trainees and is easy to construct. A simulated vagina addition increased extraction difficulty and increased the probability of balloon (amniotic sac) rupture during simulation. A hysterotomy addition enhanced model applicability for use at simulated cesarean delivery of the breech fetus.

CONCLUSION: This educational device for simulation of breech extraction realistically simulates a fetus suspended in an amniotic cavity and challenges learners to use tactile cues for prompt and proper identification, grasping, and delivery of the fetal foot or feet.

A model using readily available, inexpensive supplies replicates critical steps of breech extraction and can be used to teach trainees this important skill.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, Pennsylvania.

Corresponding author: Meredith L. Birsner, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St Luke's University Health Network, 701 Ostrum Street, Suite 303, Bethlehem, PA 18015; email:

Financial Disclosure The author did not report any potential conflicts of interest.

The author thanks Roark Birsner for assistance with device assembly and modification of the assembly, the Media Production Services staff at St. Luke's Hospital for photography, and the residents in Obstetrics and Gynecology at Thomas Jefferson University for their participation.

The author has indicated that she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.